Agenda item

An appendix to this item is included in the ‘Supporting Documents’ pack.

Matthew Cole, LBBD Director of Public Health, presented the JSNA report and explained the Statutory background, highlighting that the JSNA is required to be reviewed annually.  This was the first time that the JSNA had been produced in the form of an ‘info graphic’ style assessment and it was hoped that this would make it more user friendly.

The role of the JSNA is to provide information on the needs in the local population in health terms and the emerging demographic and health trends in order to inform key strategies, in particular the Joint Health and Wellbeing Strategy.  The JSNA forms the basis of commissioning decisions and also informs longer-term service planning for partners and the Council, for example Be First, My Place, Community Solutions. 

The Borough has challenges across the life course with a rapidly changing population, with quickly changing health needs.  The Borough’s health and social care planning must reflect its increasing numbers of births, children and young people, the numbers of middle aged people (45 to 65) with significant health issues, which was forecast to peak in 2020, as well as having a sizeable cohort of over 90s.  The details were set out in the report and particular attention was drawn to:

·  Barking and Dagenham’s performance had generally improved, but not at the same pace as other areas. 

·  Pregnancy, Maternity, Post Natal and Breastfeeding 

-   The reduction in teenage pregnancy rates had continued to improve year on year.

-   Maternity Mental Health provision for both post-natal depression and perinatal support.

-   The smoking in pregnancy rates and the whole life negative effects this can have on the child.

-   Breast is best campaigns had not had as significant impact locally so this needed to be explored further.

·  Immunisation Rates

This included maternity, early years / infant, influenza and other immunisation services.

·  Young Child Development

Increasing number of young children that had reached a good stage of development before going to school and the positive impact that would have in both their formative and later education years and life-long achievements. 

·  Education

The importance of good health in children and young people’s attendance and participation at school and college and their attitude to their own future health.

·  Life Expectancy

There had been a small improvement in life expectancy, but the rates were still not as good as other areas in London.

·  Life Style

The impact that life style had on overall life expectancy and how lifestyle choices, such as smoking, healthy diet, adult and child obesity, and lack of regular exercise continued to be a significant challenge; with the consequential poor health and medical and social support that would demand. 

·  Health checks

The impact on increasing life expectancy, reducing poor health and the need for more medical intervention, aggressive treatment and social care.

·  A&E Attendance Rates

Why were parents, especially of young children, defaulting to A&E attendance for medical support?

·  Mental Health

This was a growing area of demand, particularly in children and young people.

·  Income

Access to employment and housing and how this could impact on both physical and mental health.

The Board went on to discussed a number of issues, including:

Localities and JSNA Profile

It was noted that it was intended to break the data sets down into localities to improve understanding of the locality health issues and demands both GPs and the provider alliance.  Partners would then use the information in commissioning decisions, including challenges on service and performance for GPs. 

In response to questions Matthew Cole advised that we needed to make sure that we are doing best for our local community and do not fall into the ‘one size fits all’ trap.  It was noted that this would require a greater amount of sophistication on how to encourage lifestyle change for different sectors / demographic areas.  The Chair commented that it was important to get the community to understand how bad choices impact on health, and for individuals to reflect on their personal situations and how their own actions, in many cases, would make a difference to their long-term health. 

Brian Parrott, Independent Chair of Adult Safeguarding Board (LBBD) asked Matthew Cole what, as the Director of Public Health, were the three things he would choose to have the most impact.  Matthew responded that Income and prosperity was the key.  In his view nothing improves health faster than income levels, which could be driven long-term by young people’s education and employment opportunities.  Over and above this there are three things that the Borough could concentrate on changing Matthew advised:

·  Early years and young child health, as that created a base and good habits for life.

·  Early diagnosis and intervention

·  Resilience across all ages in dealing with significant life events or pressures.  This would include an acceptance within the local culture that anyone may need some support for mental wellbeing and the role that all staff disciplines in the partnership could provide in recognising when that support was needed and signposting individuals appropriately.  The experience and potential roles for the faith groups in this was also noted.

Sharon Morrow, Senior Responsible Officer for Unplanned Care, BHR CCGs, said that early diagnosis of disease was important as earlier intervention would reduce resource needs long-term.

Anne Bristow, LBBD Deputy Chief Executive and Strategic Director Service Development and Integration, stressed that as the number of older people is expected to grow towards 2022 and resources became more pressured, a step-change was needed to remove the concentration on the last six months performance and to increase the focus on long-term prevention and to put interventions into place which will have a positive impact five years or more into the future.

Nathan Singleton, Healthwatch, drew attention to circular references in section 3 of the document, which Matthew Cole advised he would correct.

It was noted that the Children’s Mental Health Plan would be brought to the Board for refresh for 2018-19 and this, the discussions earlier and other plans would need to be triangulated into the overall Health and Wellbeing Strategy that would be refreshed in 2018.

The Board agreed:

(i)  To take account of the findings of the Joint Strategic Needs Assessment (JSNA) in the development of its strategies and in its appraisal of strategies developed by partner organisations;

(ii)  To support the commissioning of services by partner organisations that align with the JSNA findings and the Joint Health and Wellbeing Strategy; and,

(iii)  To support the review of the JSNA process, content and format in 2018.